Electrolyte derangement in cerebral malaria: a case for a more aggressive approach to the management of hyponatraemia

Although hyponatraemia has been consistently shown to occur in a large prop ortion of children with cerebral malaria, no statistical relationship has b een established between the incidence of hyponatraemia and that of malaria- attributable mortality. However, hyponatraemia is not a benign state in oth er conditions (such as meningitis) or in surgical patients, and is likely t o add to malarial deaths. The high mortality rate seen among cases of cereb ral malaria, despite all efforts to curb it, therefore calls for a more agg ressive approach to the management of hyponatraemia. Current methods for th e administration of hypotonic saline and isotonic glucose solutions need re view. In addition, children admitted with cerebral malaria should have thei r electrolyte status monitored to identify new or ongoing hyponatraemia. Wh en hyponatraemia is discovered, it should be quickly and actively corrected .